4/1/20 - HANDSOME - PMPS 99, +.30 = 104, +2 = 251, +4 = 450

MeowMomma

MeowMomma

Member Since 2019
Hi, we need some help with dosing really quickly if anyone is on now and can help.

Started his increase to 4.25U the evening of 3/28.

His PMPS just now is 99 and I'm getting ready to feed, and then shoot. How much should I give?

Evening tests are harder to get, fyi.

Anyone?

Thank you for any help you can offer.
 
Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise

That being said, shooting lower numbers is the best way to get the best results, but if you can't test as much (and as long) as necessary on the PM cycle, your only choice is to skip. Even if you give a reduced dose, there's no guarantee that it won't be an active cycle tonight due to the depot. You'd want to get at least a +2 if you shoot any amount and be willing to test later if it's necessary
 
The concern here is that, while that 99 is a wonderful number to see, it's a lot lower than you've ever shot-- especially if you have trouble getting the evening tests. Chris has given the general guidelines on lower-than-usual pre-shots.

We're asking you to stall and re-test because it's possible that Handsome is going to be moving back up very soon. If he is, it might be possible for you to shoot (depending on how fast he's going up and what you are comfortable with). But we definitely don't want you shooting a number like this without at least the information about where he might be going from here.
 
Understood and thank you for the replies. I'll stall and test again at 5:30p. I'll post that number as soon as I take it.

I'll set my Alarms tonight and will get at least +2 and +4 numbers.
 
I think you're going to have to skip, especially if he's hungry enough to be complaining you can't stall much longer waiting for him to go up. Poor little guy!

I'd still get a +2 tonight, even without the shot-- gathering information for next time.
 
Skipping makes me so nervous. Wouldn't we have to start all over and lose the progress we've made?

I'll go ahead and feed him and keep watching this for replies. I'll get the +2 and +4 numbers tonight and add here.

Looking forward to tmrw morning - would I go back to the 4.25U or would I start lower since skipping tonight? (Based on morning number of course).
 
You'd keep the same dose. The reduction number for SLGS is 90. The 99 he saw today is a beautiful number, especially for an AT2 meter, just came at an inconvenient time, lol!

You'll lose a little momentum, but not that much. As Chris mentioned, the Lantus depot is still going to be there working for you, and you aren't going to have to rebuild that from scratch.

Overall, as frustrating as it is to skip, this is a positive development for Handsome!
 
Hopefully, the next time you get a "low" number at pre-shot, it will be something more manageable, like the high 100s. Ideally, you'll be able to work your way down slowly, shooting lower and lower numbers, until (on SLGS), you can shoot anything over 90. It's just not something we want you do do all at once, before you have some more information about how Handsome does with these kinds of numbers. But, he'll get there!
 
By the way, the guidelines that Chris posted are for caregivers who are new, which I wouldn't call you anymore. Over time and as you gather data, the guidelines change. From the Sticky Note:

Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus, Basaglar, and Levemir users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:
  • Do you need to stay on schedule? Then skip the shot.
  • Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
  • Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
If the preshot number is near kitty's usual preshot numbers:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method.

Data is your friend. Been a while since you've gotten a +1 test. Knowing how much of a bump your cat will cat with food really helps you shoot lower numbers.

But most important, let's celebrate that green today! :D
 
Bummer on the bounce. If your schedule could afford a two hour delay you could shoot now. Oh well, sleep well tonight.
 
I cant do the delay due to work. The schedule we are on is the best with my work schedule (healthcare).

I guess we just start fresh in the morning and I'll try to do better with the evening tests.

Thanks to everyone for your replies!
 
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